1. September, 2005What IHE Delivers 1 Presenters Ian Stahl, Initiate Systems PATIENT IDENTIFICATION CROSS-REFERENCING (PIX and PDQ): AS THE STRATEGIC FOUNDATION FOR INTEROPERABILITY

2. 2 Your Presenter Ian Stahl, Director of Product Management, Initiate Systems, Inc. istahl@initiatesystems.com (512) 634-5183

3. 3 The healthcare reality Volume of patient data increasing exponentially Quality of patient data declining Fragmented, duplicate and conflicting patient information within and across databases and touch points Regulatory and safety issues drive new requirements ADT Rob Johnson 1000 Main St. ADT Rob Johnson 1000 Main St. PACS Bob Johnson (555) 123-4567 PACS Bob Johnson (555) 123-4567 Lab Robert Johnson robj@aol.com Billing Bobby M. Johnson credit card# 5555-55-1234 Billing Bobby M. Johnson credit card# 5555-55-1234

4. 4 Critical Data Details Over 30% of all Master Person Index (MPI) records have an invalid or blank value in name (first/last), date of birth or gender Jumps to over 60% if middle name counted Over 80% of all confirmed duplicate records have a data discrepancy in one or more key patient identifying fields i.e., Name, date of birth, SSN/SIN or gender Nearly 40% of all duplicate records have a discrepancy in the first or last name

5. 5 Clinics, Labs, Imaging Hospital 1 Hospital 1 Hospital 2 Hospital 2 Hospital 3 Hospital 3 Physicians Network Clinical System Clinical System Pharmacy & Pharmacy Benefits Mgmt. Hospitals (for Inpatients & Outpatients) Hospitals (for Inpatients & Outpatients) Labs & Imaging Lab Systems Physician Public Health County General County General Real-time Query API Nightly Update XML Real-time Query API Real-time Updates SOAP Search Flat File Real-time Updates HL7 NCPDP Real-time Query Identity Identity Identity Identity Identity Identity Identity EHR Interoperability will drive and deliver EHR

6. 6 The Basic Questions How do I begin to integrate all these solutions? Use and insist on IHE Profiles – Templates for needed interoperability functions Use and insist on IHE Profiles – Templates for needed interoperability functions What do I use to glue these solutions together? HL7 Messages – Healthcare messaging standard already used HL7 Messages – Healthcare messaging standard already used What drives access to all the solutions? The patient – Healthcare is about the patient information The patient – Healthcare is about the patient information How do I deliver an EHR? Find the patient – Use IHE Profiles with HL7 Messages to access the patient records and other supporting data Find the patient – Use IHE Profiles with HL7 Messages to access the patient records and other supporting data

7. 7 Patient Identity Drives Interoperability Do we know this patient? Is this the correct patient? What information do I have about this patient? Where did this patient information come from? What view do I have of this patient? What else do I know about this patient? The Key to Patient Identity is:

8. 8 How Does PIX/PDQ Drive Interoperability Do we know this patient? PIX/PDQ Query from client to XRef Manager PIX/PDQ Query from client to XRef Manager Is this the correct patient? PIX/PDQ Manager must handle, accurately, the matching and linking with tunable probabilistic algorithms PIX/PDQ Manager must handle, accurately, the matching and linking with tunable probabilistic algorithms What information do I have about this patient? PIX/PDQ Manager Response to query PIX/PDQ Manager Response to query Where did this patient information come from? Domain based HL7 Messages Identify sources Domain based HL7 Messages Identify sources What view do I have of this patient? Security applied at the application, PIX/PDQ Manager, or both Security applied at the application, PIX/PDQ Manager, or both What else do I know about this patient? Extending the PIX/PDQ Manager and using other IHE profiles (i.e. XDS) Extending the PIX/PDQ Manager and using other IHE profiles (i.e. XDS) By answering the questions:

9. 9 Interoperability requires accurate patient matching and linking P&C policyholder data Claims and billing data Debbie Becker NULL 5555-55-1234 Local identifier DBECKER1234 Commercial policyholder data Debbie Becker 9146 E VILLA DEL SOL NETOWN, CA 45885 Local identifier HOSPABC98765 Store #3908, Zip = Debbie Dozier - Becker 9146 E VIA DEL SOL NETOWN, CA 45883 Local identifier 12/19/61 – 727 Debbie Dozier NEED INFO 5555-55-1234 Local identifier 12345ABCDE Web self service data Debbie Becker 9146 VIA DEL SOL 480-473-3486 Local identifier BECKER4804733486 Initiate Identity Hub software 1. 1.Derives & standardizes data for efficiency 2. 2.Finds all potential matches 3. 3.Use sophisticated probabilistic statistics to compare many attributes & score records 4. 4.Puts results in 3 buckets – link, dont link, needs manual review Trusted system of record Trusted system of record 1: 12/19/61 – 727 2: DBECKER1234 3: 12345ABCDE 4: HOSPABC98765 5: BECKER4807343486 Debbie Becker 9146 VIA DEL SOL NETOWN, CA 45883 480-473-3486 5555-55-1234

10. 10 Clinics, Labs, Imaging Hospital 1 Hospital 1 Hospital 2 Hospital 2 Hospital 3 Hospital 3 Physicians Network Clinical System Clinical System Pharmacy & Pharmacy Benefits Mgmt. Hospitals (for Inpatients & Outpatients) Hospitals (for Inpatients & Outpatients) Labs & Imaging Lab Systems Physician Public Health County General County General Real-time Query API Nightly Update XML Real-time Query API Real-time Updates SOAP Search Flat File Real-time Updates HL7 NCPDP Real-time Query Identity Identity Identity Identity Identity Identity Identity PIX/PDQ Managers change the healthcare ecosystem Trusted system of record Trusted system of record 1: 12/19/61 – 727 2: DBECKER1234 3: 12345ABCDE 4: HOSPABC98765 5: BECKER4807343486 Debbie Becker 9146 VIA DEL SOL NETOWN, CA 45883 480-473-3486 5555-55-1234

11. 11 Billing Care delivery Purchasing Research Diagnosis Treatment Scheduling Communications The invocation of the necessary services to provide the most accurate information to the right place at the right time RegistrationProcessProcess Interoperability defined Patient Payor Provider PBM Supplier Pharmacy Public Health Public Health Radiology RHIO PeoplePeople Physician Etc. ERP Clinical Rx Resource Formulary Financial Research Data DI Patient 3 rd party/ Ref. data 3 rd party/ Ref. data Etc. Provider Privacy, Security, Standards, Regulatory Compliance

12. 12 Solution Reference architecture Lab mgt EMPI HIS Clinical Financial Provider 3 rd party Radiology mgt Customer portal Business Integration Hosting Medical mgt Medication mgt Sticky applications On ramp to RHIO Business Logic Infrastructure Application Services Core Business Services Messaging Services and Source Adapters Data Services Identity Services Consulting Data Services Security Services Initiate Standards Service

13. 13 How to get started Start with choosing a solution that supports the IHE PIX/PDQ Manager functionality Choose vendors who have products that support the PIX/PDQ client to call the IHE PIX/PDQ Manager Feed the IHE PIX/PDQ Manager patient identifying information

14. 14 IHE Web site: www.IHE.net Frequently Asked Questions Integration Profiles in Technical Frameworks: Cardiology Cardiology IT Infrastructure IT Infrastructure Laboratory Laboratory Patient Care Coordination Patient Care Coordination Radiology Radiology Connectathon Results Vendor Products Integration Statements Participation in Committees & Connectathons

15. 15 Questions? Ian Stahl, Director, Product Management istahl@initiatesystems.com Bill Klaver, Healthcare Solutions Architect bklaver@initiatesystems.com www.initiatesystems.com

16. 16